Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Food Establishment Permit Application

Please put N/A for any fields that are not applicable

Establishment Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Name of Business Owner
Phone Number
Certified Food Safety Manager
Expires
Type of Establishment
Restaurant
Bar or Lounge
Catering
Convenience Store
Other

Applicant agrees that maintenance of a health permit is predicated on compliance with the Tooele County Food Service Sanitation Rules and Regulations. This permit is revocable for noncompliance. Permit is valid for one year from date of issue.

ALL EMPLOYEES WILL HAVE A VALID FOOD HANDLERS PERMIT AVAILABLE UPON REQUEST OF THE LOCAL HEALTH INSPECTOR.

Renewals
Level 1:   $100.00   Select:   Item Subtotal:  
$0.00
Level 2:   $150.00   Select:   Item Subtotal:  
$0.00
Level 3:   $225.00   Select:   Item Subtotal:  
$0.00
Level 4:   $300.00   Select:   Item Subtotal:  
$0.00
Total:
$0.00
 
Signature of Applicant
Date

Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
Late Fee If Applicable:   $   Item Subtotal:  
$0.00
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